【摘要】 目的探讨术前吲哚氰绿15 min滞留率(ICGR15)联合标准残肝体积(SRLV)检测对巨大肝细胞癌(肝癌)精准肝切除术后发生肝功能不全的预测价值。方法本前瞻性研究对象为2009年5月至2013年5月在中山大学附属第一医院行精准肝切除的110例巨大肝癌患者。所有患者均签署知情同意书,符合医学伦理学规定。其中男92例,女18例;年龄26~75岁,中位年龄48岁。肿瘤直径为10.1~20.5 cm。所有患者术前均检测ICGR15并接受薄层CT扫描。利用CT扫描数据对患者肝脏、肿瘤及血管进行三维重建,重建后进行模拟手术切除,计算SRLV。患者手术方式均采取精准肝切除术。根据术后有否发生肝功能不全,将患者分为肝功能不全组(18例)和无肝功能不全组(92例)。对术后肝功能不全发生的相关因素进行单因素分析,将筛选出来的相关因素ICGR15联合SRLV作为诊断指标进行诊断试验,寻找灵敏度和特异度最佳组合,并进行logistic回归分析,计算预测术后发生肝功能不全的回归方程。结果巨大肝癌患者精准肝切除术后肝功能不全的发生率为16.4%(18/110)。患者肝功能不全的发生与术前ICGR15、SRLV有关(Z=2.805,t=4.365;P<0.05)。将术前ICGRl5值以及SRLV作为诊断指标的灵敏度为0.78,特异度为0.89。其logistic直线回归方程为:SRLV(ml/m2)=1 104×ICGR15+298.6,回归方程可以较直观反映ICGR15与SRLV关系,回归直线图可较好地预测术后肝功能不全的发生。结论术前ICGR15联合SRLV检测能有效预测巨大肝癌肝切除术后肝功能不全的发生。更多还原

【Abstract】 Objective To investigate the predictive value of preoperative indocyanine green retention rate at 15 min(ICGR15) combined with standard remnant liver volume(SRLV) to postoperative liver dysfunction after precise hepatectomy for huge hepatocellular carcinoma(HCC). Methods A total of 110 patients with huge HCC undergoing precise hepatectomy at the First Affiliated Hospital of Sun Yat-sen University between May 2009 and May 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 110 patients, 92 were males and 18 were females with the age ranging from 26 to 75 years old and the median of 48 years old. The tumor size was from 10.1 to 20.5 cm. ICGR15 of all patients were detected and all underwent thin-slice computer tomography(CT) scan before hepatectomy. The livers, tumors and blood vessels of patients were three-dimensionally reconstructed by using the data of CT scan. The surgery was simulated and SRLV was calculated. All patients underwent precise hepatectomy. According to whether postoperative hepatic dysfunction developed, the patients were divided into two groups, the liver dysfunction group(n=18) and non-liver dysfunction group(n=92). The risk factors of postoperative liver dysfunction were analyzed by univariate analysis. The screened factors ICGR15 combined with SRLV were taken as diagnostic indicators for diagnostic tests to explore the best combination of sensitivity and specificity and regression equation for predicting postoperative liver dysfunction was calculated by logistic regression analysis. Results The incidence of liver dysfunction for patients with HCC after precise hepatectomy was 16.4%(18/110). The occurrence of liver dysfunction was associated with the preoperative ICGR15 and SRLV(Z=2.805, t=4.365; P<0.05). When the preoperative ICGRl5 and SRLV taken as diagnostic indicators, the sensitivity was 0.78 and the specif icity was 0.89. Its logistic linear regression equation was SRLV(ml/m2) = 1 104 × ICGR15 + 298.6. The regression equation may directly reflect the relationship between ICGR15 and SRLV and the regression line chart may better predict the occurrence of liver dysfunction after precise hepatectomy. Conclusion Preoperative ICGR15 combined with SRLV may efficiently predict the occurrence of postoperative liver dysfunction after precise hepatectomy for huge HCC.更多还原